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01-12-2021 | COVID-19 | Original Paper

The Association Between Neighborhood Social Vulnerability and COVID-19 Testing, Positivity, and Incidence in Alabama and Louisiana

Authors: Gabriela R. Oates, Lucia D. Juarez, Ronald Horswell, San Chu, Lucio Miele, Mona N. Fouad, William A. Curry, Daniel Fort, William B. Hillegass, Denise M. Danos

Published in: Journal of Community Health | Issue 6/2021

Abstract

Racial/ethnic and socioeconomic disparities in COVID-19 burden have been widely reported. Using data from the state health departments of Alabama and Louisiana aggregated to residential Census tracts, we assessed the relationship between social vulnerability and COVID-19 testing rates, test positivity, and incidence. Data were cumulative for the period of February 27, 2020 to October 7, 2020. We estimated the association of the 2018 Social Vulnerability Index (SVI) overall score and theme scores with COVID-19 tests, test positivity, and cases using multivariable negative binomial regressions. We adjusted for rurality with 2010 Rural–Urban Commuting Area codes. Regional effects were modeled as fixed effects of counties/parishes and state health department regions. The analytical sample included 1160 Alabama and 1105 Louisiana Census tracts. In both states, overall social vulnerability and vulnerability themes were significantly associated with increased COVID-19 case rates (RR 1.57, 95% CI 1.45–1.70 for Alabama; RR 1.36, 95% CI 1.26–1.46 for Louisiana). There was increased COVID-19 testing with higher overall vulnerability in Louisiana (RR 1.26, 95% CI 1.14–1.38), but not in Alabama (RR 0.95, 95% CI 0.89–1.02). Consequently, test positivity in Alabama was significantly associated with social vulnerability (RR 1.66, 95% CI 1.57–1.75), whereas no such relationship was observed in Louisiana (RR 1.05, 95% CI 0.98–1.12). Social vulnerability is a risk factor for COVID-19 infection, particularly among racial/ethnic minorities and those in disadvantaged housing conditions without transportation. Increased testing targeted to vulnerable communities may contribute to reduction in test positivity and overall COVID-19 disparities.

Millett, G. A., Jones, A. T., Benkeser, D., Baral, S., Mercer, L., Beyrer, C., & Sullivan, P. S. (2020). Assessing differential impacts of COVID-19 on black communities. Annals of Epidemiology, 47, 37–44. https://doi.org/10.1016/j.annepidem.2020.05.003CrossRefPubMedPubMedCentral

Yancy, C. W. (2020). COVID-19 and African Americans. JAMA, 323(19), 1891–1892. https://doi.org/10.1001/jama.2020.6548CrossRefPubMed

Lieberman-Cribbin, W., Tuminello, S., Flores, R. M., & Taioli, E. (2020). Disparities in COVID-19 Testing and Positivity in New York City. American Journal of Preventive Medicine, 59(3), 326–332. https://doi.org/10.1016/j.amepre.2020.06.005CrossRefPubMedPubMedCentral

Thakur, N., Lovinsky-Desir, S., Bime, C., Wisnivesky, J. P., & Celedon, J. C. (2020). The Structural and social determinants of the racial/ethnic disparities in the US COVID-19 pandemic what’s our role? American Journal of Respiratory and Critical Care Medicine, 202(7), 943–949. https://doi.org/10.1164/rccm.202005-1523PPCrossRefPubMedPubMedCentral

Turner-Musa, J., Ajayi, O., & Kemp, L. (2020). Examining social determinants of health, stigma, and COVID-19 disparities. Healthcare (Basel), 8(2), 168. https://doi.org/10.3390/healthcare8020168CrossRef

Khalatbari-Soltani, S., Cumming, R. C., Delpierre, C., & Kelly-Irving, M. (2020). Importance of collecting data on socioeconomic determinants from the early stage of the COVID-19 outbreak onwards. Journal of Epidemiology and Community Health, 74(8), 620–623. https://doi.org/10.1136/jech-2020-214297CrossRefPubMed

Rodriguez-Diaz, C. E., Guilamo-Ramos, V., Mena, L., Hall, E., Honermann, B., Crowley, J. S., & Millett, G. A. (2020). Risk for COVID-19 infection and death among Latinos in the United States: examining heterogeneity in transmission dynamics. Annals of Epidemiology, 52(46–53), e42. https://doi.org/10.1016/j.annepidem.2020.07.007CrossRef

Macias Gil, R., Marcelin, J. R., Zuniga-Blanco, B., Marquez, C., Mathew, T., & Piggott, D. A. (2020). COVID-19 pandemic: disparate health impact on the hispanic/latinx population in the United States. Journal of Infectious Diseases, 222(10), 1592–1595. https://doi.org/10.1093/infdis/jiaa474CrossRef

Caldwell, S. H., & Popenoe, R. (1995). Perceptions and misperceptions of skin color. Annals of Internal Medicine, 122(8), 614–617. https://doi.org/10.7326/0003-4819-122-8-199504150-00010CrossRefPubMed

10.

Kahn, J. (2004). How a drug becomes “ethnic”: law, commerce, and the production of racial categories in medicine. Yale J Health Policy Law Ethics, 4(1): 1–46. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15052858

11.

Hoover, E. L. (2007). There is no scientific rationale for race-based research. Journal of the National Medical Association, 99(6): 690–692. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17595942

12.

Abedi, V., Olulana, O., Avula, V., Chaudhary, D., Khan, A., Shahjouei, S., & Zand, R. (2020). Racial, economic, and health inequality and COVID-19 infection in the United States. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-020-00833-4CrossRefPubMedPubMedCentral

13.

Lewis, N. M., Friedrichs, M., Wagstaff, S., Sage, K., LaCross, N., Bui, D., & Dunn, A. (2020). Disparities in COVID-19 incidence, hospitalizations, and testing, by area-level deprivation - Utah, March 3-July 9, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(38), 1369–1373. https://doi.org/10.15585/mmwr.mm6938a4CrossRefPubMedPubMedCentral

14.

Zhang, C. H., & Schwartz, G. G. (2020). Spatial disparities in coronavirus incidence and mortality in the united states: an ecological analysis as of May 2020. Journal of Rural Health, 36(3), 433–445. https://doi.org/10.1111/jrh.12476CrossRef

15.

Maroko, A. R., Nash, D., & Pavilonis, B. T. (2020). COVID-19 and inequity: a comparative spatial analysis of New York City and Chicago hot spots. Journal of Urban Health, 97(4), 461–470. https://doi.org/10.1007/s11524-020-00468-0CrossRefPubMedPubMedCentral

16.

Rozenfeld, Y., Beam, J., Maier, H., Haggerson, W., Boudreau, K., Carlson, J., & Medows, R. (2020). A model of disparities: risk factors associated with COVID-19 infection. Int J Equity Health, 19(1), 126. https://doi.org/10.1186/s12939-020-01242-zCrossRefPubMedPubMedCentral

17.

Rentsch, C. T., Kidwai-Khan, F., Tate, J. P., Park, L. S., King, J. T., Jr., Skanderson, M., & Justice, A. C. (2020). Covid-19 by race and ethnicity: a national cohort study of 6 million United States Veterans. medRxiv. https://doi.org/10.1101/2020.05.12.20099135CrossRefPubMedPubMedCentral

18.

Goyal, M. K., Simpson, J. N., Boyle, M. D., Badolato, G. M., Delaney, M., McCarter, R., & Cora-Bramble, D. (2020). Racial and/or Ethnic and Socioeconomic Disparities of SARS-CoV-2 Infection Among Children. Pediatrics, 146(4), e2020009951. https://doi.org/10.1542/peds.2020-009951CrossRefPubMed

19.

Whittle, R. S., & Diaz-Artiles, A. (2020). An ecological study of socioeconomic predictors in detection of COVID-19 cases across neighborhoods in New York City. BMC Medicine, 18(1), 271. https://doi.org/10.1186/s12916-020-01731-6CrossRefPubMed

20.

Dasgupta, S., Bowen, V. B., Leidner, A., Fletcher, K., Musial, T., Rose, C., & Oster, A. M. (2020). Association between social vulnerability and a county’s risk for becoming a COVID-19 hotspot - United States, June 1-July 25, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(42), 1535–1541. https://doi.org/10.15585/mmwr.mm6942a3CrossRefPubMedPubMedCentral

21.

Karaye, I. M., & Horney, J. A. (2020). The impact of social vulnerability on COVID-19 in the U.S. an analysis of spatially varying relationships. American Journal of Preventive Medicine, 59(3), 317–325. https://doi.org/10.1016/j.amepre.2020.06.006CrossRefPubMedPubMedCentral

22.

Neelon, B., Mutiso, F., Mueller, N. T., Pearce, J. L., & Benjamin-Neelon, S. E. (2021). Spatial and temporal trends in social vulnerability and COVID-19 incidence and death rates in the United States. PLoS ONE, 16(3), e0248702. https://doi.org/10.1371/journal.pone.0248702CrossRefPubMedPubMedCentral

23.

Nayak, A., Islam, S. J., Mehta, A., Ko, Y. A., Patel, S. A., Goyal, A., & Quyyumi, A. A. (2020). Impact of social vulnerability on COVID-19 incidence and outcomes in the United States. medRxiv. https://doi.org/10.1101/2020.04.10.20060962CrossRefPubMedPubMedCentral

24.

Biggs, E. N., Maloney, P. M., Rung, A. L., Peters, E. S., & Robinson, W. T. (2020). The relationship between social vulnerability and COVID-19 incidence among louisiana census tracts. Frontiers in Public Health, 8, 617976. https://doi.org/10.3389/fpubh.2020.617976CrossRefPubMed

25.

CDC’s Social Vulnerability Index (SVI) data and documentation download. (2020). Washington, DC: ATSDR Retrieved from https://svi.cdc.gov/data-and-tools-download.html

26.

Rural-Urban Commuting Area Codes. (2020). Retrieved from https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/. from United States Department of Agriculture, Economic Research Service https://www.ers.usda.gov/data-products/rural-urban-commuting-area-codes/

27.

Wolfinger, R., & O’Connell, M. (1993). Generalized linear mixed models: a pseudo-likelihood approach. Journal of Statistical Computation and Simulation, 48(3–4), 233–243. https://doi.org/10.1080/00949659308811554CrossRef

28.

Williams, D. R. (1999). Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci, 896, 173–188. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10681897

29.

Marmot, M. (2015). The health gap: the challenge of an unequal world. The Lancet, 386(10011), 2442–2444. https://doi.org/10.1016/S0140-6736(15)00150-6CrossRef

30.

Bateman, L. B., Schoenberger, Y. M., Hansen, B., Osborne, T. N., Okoro, G. C., Speights, K. M., & Fouad, M. N. (2021). Confronting COVID-19 in under-resourced, African American neighborhoods: a qualitative study examining community member and stakeholders’ perceptions. Ethnicity and Health, 26(1), 49–67. https://doi.org/10.1080/13557858.2021.1873250CrossRefPubMed

31.

Cordes, J., & Castro, M. C. (2020). Spatial analysis of COVID-19 clusters and contextual factors in New York City. Spat Spatiotemporal Epidemiol, 34, 100355. https://doi.org/10.1016/j.sste.2020.100355CrossRefPubMedPubMedCentral

32.

Dryden-Peterson, S., Velasquez, G. E., Stopka, T. J., Davey, S., Lockman, S., & Ojikutu, B. O. (2021). Disparities in SARS-CoV-2 testing in massachusetts during the COVID-19 pandemic. JAMA Network Open, 4(2), e2037067. https://doi.org/10.1001/jamanetworkopen.2020.37067CrossRefPubMedPubMedCentral

33.

Mathur, M. B., Ding, P., Riddell, C. A., & VanderWeele, T. J. (2018). Web Site and R package for computing E-values. Epidemiology, 29(5), e45–e47. https://doi.org/10.1097/EDE.0000000000000864CrossRefPubMedPubMedCentral

34.

VanderWeele, T. J., & Ding, P. (2017). Sensitivity Analysis in Observational Research: Introducing the E-Value. Annals of Internal Medicine, 167(4), 268–274. https://doi.org/10.7326/M16-2607CrossRefPubMed

Title: The Association Between Neighborhood Social Vulnerability and COVID-19 Testing, Positivity, and Incidence in Alabama and Louisiana
Authors: Gabriela R. Oates
Lucia D. Juarez
Ronald Horswell
San Chu
Lucio Miele
Mona N. Fouad
William A. Curry
Daniel Fort
William B. Hillegass
Denise M. Danos
Publication date: 01-12-2021
Publisher: Springer US
Keyword: COVID-19
Published in: Journal of Community Health / Issue 6/2021
Print ISSN: 0094-5145
Electronic ISSN: 1573-3610
DOI: https://doi.org/10.1007/s10900-021-00998-x

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The Association Between Neighborhood Social Vulnerability and COVID-19 Testing, Positivity, and Incidence in Alabama and Louisiana

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